CRNI Infection Control 2 — Questions and Answers
Question 1: What is the recommended maximum dwell time for a peripheral IV catheter in an adult patient?
- 24 hours
- 48 hours
- 72-96 hours or based on clinical assessment (Correct answer)
- 7 days
Correct answer: 72-96 hours or based on clinical assessment
Current INS guidelines recommend replacing peripheral IV catheters every 72-96 hours or based on clinical indication, balancing infection risk with patient comfort.
The INS Standards of Practice have evolved from mandatory 72-hour rotation to a clinical assessment-based approach. While 72-96 hours remains the general guideline, replacement should also be guided by clinical indicators: signs of phlebitis, infiltration, or infection. Research shows that clinically-indicated replacement (when complications arise) is as safe as routine scheduled replacement. The CRNI should assess the site at least every 4 hours (or every 1-2 hours for certain infusions), document site condition using a standardized phlebitis scale, and replace the catheter when clinical indicators warrant it.
Question 2: Which antiseptic solution is recommended as the FIRST-LINE agent for central line dressing changes?
- Povidone-iodine
- 70% isopropyl alcohol
- Chlorhexidine gluconate with alcohol (Correct answer)
- Hydrogen peroxide
Correct answer: Chlorhexidine gluconate with alcohol
Chlorhexidine gluconate (greater than 0.5%) with alcohol is the preferred antiseptic for central line site care due to its superior and prolonged antimicrobial activity.
Chlorhexidine gluconate (CHG) greater than 0.5% in alcohol is the gold standard antiseptic for central line care per CDC and INS guidelines. It provides broad-spectrum antimicrobial activity with residual effectiveness that persists on the skin for up to 48 hours (unlike povidone-iodine which loses efficacy when dry). Application technique matters: use a back-and-forth scrubbing motion for at least 30 seconds, allow to dry completely before applying the dressing. For patients with CHG allergy, povidone-iodine or 70% alcohol are alternatives. CHG-impregnated dressings provide additional protection and are recommended for short-term CVCs.
Question 3: What is the proper technique for performing a catheter hub scrub to prevent CLABSI?
- Quick wipe with an alcohol pad
- Vigorous scrubbing for at least 5-15 seconds with 70% alcohol or CHG (Correct answer)
- Soaking the hub in antiseptic solution for 1 minute
- Spraying the hub with antiseptic and allowing air dry
Correct answer: Vigorous scrubbing for at least 5-15 seconds with 70% alcohol or CHG
Hub scrubbing requires vigorous mechanical friction with an antiseptic for at least 5-15 seconds before each access to reduce intraluminal contamination.
Needleless connector decontamination (scrub the hub) is a critical CLABSI prevention measure. The technique requires vigorous mechanical scrubbing (not just passive wiping) with 70% isopropyl alcohol, CHG, or povidone-iodine for a minimum of 5-15 seconds (varies by institutional policy, some recommend up to 15 seconds). The friction physically dislodges biofilm and microorganisms. After scrubbing, the hub must be allowed to dry before access. This must be performed before every entry into the system. Passive disinfection caps containing 70% alcohol are an adjunct but do not replace active hub scrubbing per many institutional protocols.
Question 4: Which bundle element is MOST effective in reducing central line-associated bloodstream infections?
- Daily chlorhexidine bathing
- Maximum sterile barrier precautions during insertion (Correct answer)
- Antibiotic lock therapy
- Routine catheter exchange over guidewire
Correct answer: Maximum sterile barrier precautions during insertion
Maximum sterile barrier precautions during CVC insertion, including cap, mask, sterile gown, sterile gloves, and large sterile drape, significantly reduces CLABSI rates.
The Central Line Bundle, developed by the Institute for Healthcare Improvement, includes five evidence-based interventions, with maximum sterile barrier precautions during insertion being one of the most impactful. This includes: cap, mask, sterile gown, sterile gloves, and a full-body sterile drape. Studies show this reduces CLABSI by up to 6-fold compared to standard precautions. The complete bundle also includes: hand hygiene, chlorhexidine skin antisepsis, optimal catheter site selection (avoiding femoral), and daily review of line necessity. Bundle compliance must be 100% - partial compliance significantly diminishes effectiveness.
Question 5: A patient with a PICC line develops redness, swelling, and purulent drainage at the insertion site. What should the nurse suspect?
- Mechanical phlebitis
- Exit site infection (Correct answer)
- Catheter-related bloodstream infection
- Contact dermatitis from the dressing
Correct answer: Exit site infection
Redness, swelling, and purulent drainage at the catheter insertion site are classic signs of an exit site infection requiring culture and potential catheter removal.
Exit site infections are characterized by erythema, tenderness, induration, and/or purulent drainage within 2 cm of the catheter exit site, without bloodstream infection. The CRNI should obtain a culture of any drainage, assess for additional signs of systemic infection (fever, elevated WBC), and notify the provider. Treatment may include topical or systemic antibiotics; catheter removal is indicated if the infection does not resolve with treatment. Distinguishing exit site infection from mechanical phlebitis (no purulence) and tunnel infection (extending more than 2 cm from exit site) is important for appropriate management.
Question 6: How frequently should transparent semipermeable membrane (TSM) dressings on central venous catheters be changed?
- Every 24 hours
- Every 48 hours
- Every 5-7 days or when soiled, loosened, or damp (Correct answer)
- Every 14 days
Correct answer: Every 5-7 days or when soiled, loosened, or damp
TSM dressings on CVCs should be changed every 5-7 days per INS standards, or sooner if the integrity is compromised by soiling, loosening, or moisture.
Transparent semipermeable membrane (TSM) dressings on central venous catheters should be changed every 5-7 days under normal conditions per INS and CDC guidelines. They must be changed sooner if the dressing becomes damp, loosened, soiled, or if the site needs assessment due to clinical concern. Gauze dressings (used when the site is bleeding or diaphoretic) require more frequent changes, every 48 hours. Each dressing change is an opportunity for thorough site assessment and antiseptic application. The date and time of dressing change and the nurse's initials should be documented on the dressing.
CRNI Infection Control 2
What is the recommended maximum dwell time for a peripheral IV catheter in an adult patient?